突破孕期营养迷局：揭示地中海饮食如何影响围产期结果！—— 一项系统综述和Meta分析的重要发现

Association between the Maternal Mediterranean Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis

孕产妇地中海饮食与围产期结局之间的联系：系统综述和Meta分析

Authors: Jirong Xu, Haixia Wang, Jingfeng Bian, Ming Xu, Nan Jiang, Wei Luo, Ping Zu, Wanjun Yin, and Peng Zhu

Source: Adv Nutr. 2024 Feb; 15(2): 100159.

DOI: 10.1016/j.advnut.2023.100159

Abstract

Background:Mediterranean diet is a global, well-known healthy dietary pattern.

Objective:This review aims to synthesize the existing evidence on the relationship between the maternal Mediterranean diet during pregnancy and perinatal outcomes, including randomized controlled trials (RCTs) and cohort studies.

Method:PubMed, Web of Science, and the Cochrane Library were searched from inception to 10 March, 2023, supplemented by manual screening. A random-effect model was used to estimate pooled sizes with 95% confidence intervals (CIs) for specific outcomes of interest.

Results:Data from 5 RCTs and 18 cohort studies with 107,355 pregnant participants were synthesized. In RCTs, it was observed that the maternal Mediterranean diet significantly reduced the incidence of gestational diabetes mellitus [odds ratio (OR), 0.56; 95% CI: 0.34, 0.93], as well as small for gestational age (0.55; 95% CI: 0.35, 0.88). In cohort studies, the highest adherence score to the maternal Mediterranean diet was inversely associated with a lower risk of various adverse pregnancy outcomes, including gestational diabetes mellitus (OR, 0.82; 95% CI: 0.67, 1.00), pregnancy-induced hypertension (0.73; 95% CI: 0.60, 0.89), pre-eclampsia (0.77; 95% CI: 0.64, 0.93), preterm delivery (0.67; 95% CI: 0.49, 0.91), low birth weight (0.70; 95% CI: 0.64, 0.78), intrauterine growth restriction (0.46; 95% CI: 0.23, 0.91), and increased gestational age at delivery (weighted mean difference, 0.11 wk; 95% CI: 0.03, 0.20). Meta-regression analyses did not identify the adjustment for confounders and geographical location as predictive factors for heterogeneity.

Conclusions:The results suggest that adherence to the Mediterranean diet during pregnancy appears to be beneficial for perinatal outcomes. Future, larger, and higher-quality RCTs and cohort studies are warranted to confirm the present findings.

PROSPERO registration no.: CRD42023406317.

Keywords: Mediterranean diet, dietary pattern, pregnancy, perinatal outcomes, fetal outcomes, maternal outcomes, neonatal outcomes, meta-analysis

摘要

背景 地中海饮食是一种众所周知的健康饮食模式。

目的 系统性审查关于孕期地中海饮食与围产期结局之间关系的所有现有证据，包括随机对照实验（RCT）和队列研究。

方法 截止至2023年3月10日，在PubMed、Web of Science和Cochran Library上进行了搜索相关研究，并以人工筛选补充。使用随机效应模型来估计合并效应量及95%置信区间（95% CI）的大小，以得到特定围产期结局的风险。

结果 共纳入5个RCTs和18个队列研究，包括了107,355名怀孕参与者。在RCT的累积分析中，观察到孕期坚持地中海饮食显著降低了妊娠期糖尿病（OR，0.56；95%CI：0.34，0.93），以及LGA的发病率（0.55；95%CI：0.35，0.88）。队列研究汇总分析表明，与最低依从性的孕产妇地中海饮食相比，其最高依从性与降低多种不良妊娠结局的风险显著相关，包括妊娠期糖尿病（OR，0.82；95%CI：0.67，1.00），妊娠期高血压（0.73；95%CI：0.60，0.89），子痫前期（0.77；95%CI：0.64，0.93），早产（0.67；95%CI：0.49，0.91），低出生体重（0.70；95%CI：0.64，0.78），宫内生长受限（0.46；95%CI：0.23，0.91），以及增加分娩时的妊娠年龄（WMD，0.11 wk；95%CI：0.03，0.20）。此外亚组分析和Meta回归分析并没有确定混杂因素和地理位置的调整是本研究异质性的主要来源。

结论 怀孕期间坚持地中海饮食与围产期结局的显著改善有关，且未来有必要进行更大和更高质量的RCTs和队列研究进一步验证。